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An investigation of the foot ankle joint mobility, muscle strength, and foot structure in adolescent with type 1 diabetes

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Abstract

Muscle strength and joint mobility were decreased with type 1 diabetes mellitus (T1DM). However, the literature is limited about foot muscle strength, joint mobility, and structure in adolescent aged 13–17 with T1DM. The purpose of this study was to compare foot structure, muscle strength, and joint mobility of adolescents aged between 13 and 17 with T1DM to those of healthy adolescents. Cross-sectional study design including adolescents with T1DM aged 13–17 years, and healthy adolescents was used in the study. The range of motion (ROM) was measured by using a digital goniometer, and muscle strength was evaluated by using handheld-dynamometry. Footprint was used for foot structure. Assessments were performed by using the digital images, and Clarke’s angle (CA), Staheli Arch index (SAI), and Chippaux-Smirak index (CSI) were calculated by using a scientific image-analysis program, ImageJ. Forty-one T1DM and 28 healthy adolescents were included with a mean age of 15.29 ± 1.55 and 15.04 ± 1.42, respectively. The T1DM group had significantly lower dorsiflexion, inversion and eversion ROM, and lower tibialis anterior and gastrocnemius muscle test (p < 0.05, for all) compared with the control group. Statistically, significant differences were found in the right SAI and CSI between groups (p < 0.05), whereas no difference was found in CA (p > 0.05). Adolescents with T1DM have lower ankle and foot joint mobility and muscle strength and altered foot structure compared to their healthy contemporaries. This indicates that early screening of muscle strength and foot structure are important to determine and avoid various risks such as foot deformities, gait deviations, and ulcer.

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References

  1. Lopez-Miranda J, Perez-Martinez P, Marin C, Fuentes F, Delgado J, Perez-Jimenez F. Dietary fat, genes and insulin sensitivity. J Mol Med (Berl). 2007;85(3):213–26.

    Article  CAS  Google Scholar 

  2. VanBuecken D, Lord S, Greenbaum CJ. Changing the course of disease in type 1 diabetes. In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, et al., editors. Endotext. South Dartmouth: MDText.com, Inc.; 2000.

    Google Scholar 

  3. Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M. Diabetes in the young—a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract. 2014;103(2):161–75.

    Article  PubMed  Google Scholar 

  4. Sheehan AM, While AE, Coyne I. The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med. 2015;32(4):440–58.

    Article  CAS  PubMed  Google Scholar 

  5. Amin N, Doupis J. Diabetic foot disease: from the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7(7):153–64.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Merashli M, Chowdhury TA, Jawad AS. Musculoskeletal manifestations of diabetes mellitus. QJM. 2015;108(11):853–7.

    Article  CAS  PubMed  Google Scholar 

  7. Andreassen CS, Jakobsen J, Ringgaard S, Ejskjaer N, Andersen H. Accelerated atrophy of lower leg and foot muscles—a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia. 2009;52(6):1182–91.

    Article  CAS  PubMed  Google Scholar 

  8. Andersen H, Nielsen S, Mogensen CE, Jakobsen J. Muscle strength in type 2 diabetes. Diabetes. 2004;53(6):1543–8.

    Article  CAS  PubMed  Google Scholar 

  9. Andersen H, Gadeberg PC, Brock B, Jakobsen J. Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia. 1997;40(9):1062–9.

    Article  CAS  PubMed  Google Scholar 

  10. Andersen H, Gjerstad MD, Jakobsen J. Atrophy of foot muscles: a measure of diabetic neuropathy. Diabetes Care. 2004;27(10):2382–5.

    Article  PubMed  Google Scholar 

  11. Boulton AJ. The pathogenesis of diabetic foot problems: an overview. Diabet Med. 1996;13(Suppl 1):S12–6.

    PubMed  Google Scholar 

  12. Erol K, Karahan AY, Kerimoglu U, Ordahan B, Tekin L, Sahin M, et al. An important cause of pes planus: the posterior tibial tendon dysfunction. Clin Pract. 2015;5(1):699.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Allan J, Munro W, Figgins E. Foot deformities within the diabetic foot and their influence on biomechanics: a review of the literature. Prosthetics Orthot Int. 2016;40(2):182–92.

    Article  Google Scholar 

  14. Rosenbaum AJ, Lisella J, Patel N, Phillips N. The cavus foot. Med Clin North Am. 2014;98(2):301–12.

    Article  PubMed  Google Scholar 

  15. Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon). 2013;28(8):831–45.

    Article  Google Scholar 

  16. Toth C, Hebert V, Gougeon C, Virtanen H, Mah JK, Pacaud D. Motor unit number estimations are smaller in children with type 1 diabetes mellitus: a case-cohort study. Muscle Nerve. 2014;50(4):593–8.

    Article  PubMed  Google Scholar 

  17. Margeirsdottir HD, Larsen JR, Kummernes SJ, Brunborg C, Dahl-Jorgensen K. The establishment of a new national network leads to quality improvement in childhood diabetes: implementation of the ISPAD Guidelines. Pediatr Diabetes. 2010;11(2):88–95.

    Article  PubMed  Google Scholar 

  18. Clarkson HM. Musculoskeletal assessment: joint range of motion and manual muscle strength: Lippincott Williams & Wilkins; 2000.

  19. Hebert LJ, Maltais DB, Lepage C, Saulnier J, Crete M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther. 2011;23(3):289–99.

    Article  PubMed  Google Scholar 

  20. Wever A, Schickenberg-Werrij BG, Willems J, Schaper NC, Schott DA. Prevalence and awareness of functional and structural foot abnormalities in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2016; doi:10.1515/jpem-2015-0455.

    PubMed  Google Scholar 

  21. Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM R. 2011;3(5):472–9.

    Article  PubMed  Google Scholar 

  22. Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, et al. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve. 2001;24(6):787–93.

    Article  CAS  PubMed  Google Scholar 

  23. Clarke HH. An objective method of measuring the height of the longitudinal arch in foot examinations. Research Quarterly American Physical Education Association. 1933;4(3):99–107.

    Google Scholar 

  24. Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait & posture. 2002;15(3):282–91.

    Article  Google Scholar 

  25. Chen KC, Yeh CJ, Kuo JF, Hsieh CL, Yang SF, Wang CH. Footprint analysis of flatfoot in preschool-aged children. Eur J Pediatr. 2011;170(5):611–7.

    Article  PubMed  Google Scholar 

  26. Staheli LT, Chew DE, Corbett M. The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426–8.

    Article  CAS  PubMed  Google Scholar 

  27. Forriol F, Pascual J. Footprint analysis between three and seventeen years of age. Foot Ankle. 1990;11(2):101–4.

    Article  CAS  PubMed  Google Scholar 

  28. Queen RM, Mall NA, Hardaker WM, Nunley II. JA. Describing the medial longitudinal arch using footprint indices and a clinical grading system. Foot & ankle international. 2007;28(4):456–62.

    Article  Google Scholar 

  29. Echarri JJ, Forriol F. The development in footprint morphology in 1851 Congolese children from urban and rural areas, and the relationship between this and wearing shoes. J Pediatr Orthop B. 2003;12(2):141–6.

    PubMed  Google Scholar 

  30. Rosenbloom AL. Limited joint mobility in childhood diabetes: discovery, description, and decline. J Clin Endocrinol Metab. 2013;98(2):466–73.

    Article  CAS  PubMed  Google Scholar 

  31. Francia P, Seghieri G, Gulisano M, De Bellis A, Toni S, Tedeschi A, et al. The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer. Diabetes Res Clin Pract. 2015;108(3):398–404.

    Article  PubMed  Google Scholar 

  32. Nagesh VS, Kalra S. Type 1 diabetes: syndromes in resource-challenged settings. J Pak Med Assoc. 2015;65(6):681–5.

    PubMed  Google Scholar 

  33. Greenman RL, Khaodhiar L, Lima C, Dinh T, Giurini JM, Veves A. Foot small muscle atrophy is present before the detection of clinical neuropathy. Diabetes Care. 2005;28(6):1425–30.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Barnett SJ, Shield JP, Potter MJ, Baum JD. Foot pathology in insulin dependent diabetes. Arch Dis Child. 1995;73(2):151–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. van Schie CH, Vermigli C, Carrington AL, Boulton A. Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Diabetes Care. 2004;27(7):1668–73.

    Article  PubMed  Google Scholar 

  36. Cheuy VA, Hastings MK, Commean PK, Mueller MJ. Muscle and joint factors associated with forefoot deformity in the diabetic neuropathic foot. Foot & ankle international. 2015; doi:10.1177/1071100715621544.

    Google Scholar 

  37. Kothari A, Bhuva S, Stebbins J, Zavatsky AB, Theologis T. An investigation into the aetiology of flexible flat feet: the role of subtalar joint morphology. Bone Joint J. 2016;98-b(4):564–8.

    Article  CAS  PubMed  Google Scholar 

  38. Aggarwal N, Garg C, Bawa H. Comparison of foot posture in runners (sprinters) and non runners in Indian population. The Physiotherapy Post. 6(1):268–71.

  39. Riddiford-Harland DL, Steele JR, Storlien LH. Does obesity influence foot structure in prepubescent children? International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 2000;24(5):541–4.

    Article  CAS  Google Scholar 

  40. Pita-Fernandez S, Gonzalez-Martin C, Seoane-Pillado T, Lopez-Calvino B, Pertega-Diaz S, Gil-Guillen V. Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older. Journal of epidemiology. 2015;25(2):148–54.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Villarroya MA, Esquivel JM, Tomas C, Moreno LA, Buenafe A, Bueno G. Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study. Eur J Pediatr. 2009;168(5):559–67.

    Article  PubMed  Google Scholar 

  42. Francia P, Anichini R, De Bellis A, Seghieri G, Lazzeri R, Paternostro F, et al. Diabetic foot prevention: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed. Ital J Anat Embryol. 2015;120(1):21–32.

    PubMed  Google Scholar 

  43. Singla R, Gupta Y, Kalra S. Musculoskeletal effects of diabetes mellitus. J Pak Med Assoc. 2015;65(9):1024–7.

    PubMed  Google Scholar 

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Acknowledgments

We thank all the participants involved in the survey. The help of ……..Omer Inan from …….Bandirma Onyedi Eylul University for the English review of the manuscript is very much acknowledged.

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Correspondence to Ebru Kaya Mutlu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kaya Mutlu, E., Unver, B., Taskiran, H. et al. An investigation of the foot ankle joint mobility, muscle strength, and foot structure in adolescent with type 1 diabetes. Int J Diabetes Dev Ctries 38, 108–114 (2018). https://doi.org/10.1007/s13410-017-0556-3

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  • DOI: https://doi.org/10.1007/s13410-017-0556-3

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